Provider Demographics
NPI:1801906920
Name:CONLAN, BRIAN (MSW LCSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:CONLAN
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201
Mailing Address - Country:US
Mailing Address - Phone:818-956-0101
Mailing Address - Fax:818-956-1413
Practice Address - Street 1:6425 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201
Practice Address - Country:US
Practice Address - Phone:818-956-0101
Practice Address - Fax:818-956-1413
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS4412101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS4412OtherCALIFORNIA
S19825Medicare UPIN
CASW4412Medicare ID - Type Unspecified